Contraception Chapter 6

Principles of Contraception Types of contraception: Hormonal methods work by suppressing ovulation, thickening the cervical mucus, or thinning the endometrium Barrier methods are physical barriers to conception Natural methods make use of a woman’s fertile time of the month Surgical methods involve a medical visit and whole body or local anesthetics

Effectiveness Contraceptive failure rate- % of women experiencing an unintended pregnancy in the 1st yr. of contraceptive use Continuation rate- % of people who continue to use the method after a specified period of time

hormonal Methods

Oral Contraceptives: The Pill Hormonal contraceptive Mimics the corpus luteum releases estrogen & progestin (combination pill) Most common type of birth control Advantages: Easy to use, effective, fertility returns after use Disadvantages : no protection against STD’s, exp. symptoms of pregnancy, prescription required, stroke, blood clots in older women who smoke

Contraceptive Skin Patch Hormonal contraceptive Releases estrogen and progestin into bloodstream Prevents pregnancy the same way as OCs Worn for 1 week, replaced on the same day for 3 consecutive weeks. 4th wk. no patch Advantages: same as OC’s, week long protection Disadvantages: same as OC’s; skin irritation

Vaginal Contraceptive Ring Hormonal contraceptive Flexible vaginal ring molded w/ progesterone and estrogen releases estrogen and progestin into bloodstream Worn for 3 wks., removed at start of 4th wk. (ring free) new ring inserted same day, following wk. Advantages : 1 month of protection, no daily/weekly action required Disadvantages : similar to OCs and patch

Contraceptive Implants Hormonal contraceptive Placed under skin of upper arm/leg Delivers progesterone over a period of 4 years Advantages: Highly effective, no further action required after insertion, contains no estrogen, so no estrogen related side effects Disadvantages: no protection against STDs, menstrual irregularities, uncomfortable appearance, requires medical visit to start or stop use

Injectable Contraceptives Depo-Provera Injectable progestin every 12 weeks Provides protection like implants Advantages: Highly effective, requires little action on part of user ; No estrogen- related side effects, minor injection Disadvantages: requires medical visit to start or stop use (every 3 months), weight gain, infertility after stopping use

The Intrauterine Device (IUD) Small plastic device placed in the uterus ParaGard (copper; protects up to10 yrs.) Mirena (protects up to 5 yrs.) Releases small amounts of progestin Advantages: highly reliable, once inserted a simple check of string is all that’s needed; reduced risk of endometrial cancer; fertility restored after use Disadvantages: heavy menstrual flow, uterine cramping, backache, spontaneous expulsion, requires medical visit to start or stop use

Emergency Contraception “Morning-after Pill”, Plan B Should not be used as a contraceptive but can be used if birth control has failed, if forced to have sex, etc. Most common is the two dose regimen Needs to be taken within 72 hrs. but best when used within 24 hrs. May inhibit/delay ovulation or altering the transport of sperm/egg; does not affect a fertilized, implanted egg

Figure 6.1 An IUD properly positioned in the uterus Figure 6-1: An IUD (Copper T-380A) properly positioned in the uterus.

Barrier Methods

Male Condoms Thin latex, or polyurethane Most widely used barrier method Advantages: Protects against pregnancy and STD’s, easy to purchase, no prescription Disadvantages: Most common complaints are reduced sensitivity and having to apply it right before intercourse

Female Condoms Polyurethane sheath with two flexible rings Advantages: offers potentially more protection against genital warts and herpes b/c it covers base of penis Disadvantage: more expensive, more difficult to use

Figure 6.3 The female condom Figure 6-3 The female condom properly positioned

Natural Methods

Abstinence Abstinence Without sexual intercourse for a chosen period of time Benefits Less worry about STDs and Pregnancy

The Fertility Awareness Method Only one egg released each month Lives for ~ 24 hrs. unless fertilized Sperm can live in the body for 6-7 days Approximately 5 days/month when conception can happen Fertility Awareness method (FAM) Calendar method A woman releases an egg 14-16 days before her next period Temperature method A woman’s BT drops slightly before ovulation and rises slightly after Withdrawal Coitus interruptus

surgical Methods

Vasectomy Severing of the vas deferentia Semen still produced, but w/o sperm Takes ~ 30 min. and can return to work in 2 days.

Tubal Sterilization Tubal sterilization (laparoscopy) is most commonly known as tubal ligation An invasive surgical procedure that can have severe side effects like heavy bleeding, weight gain, decreased sex drive, etc.

Figure 6.8 Tubal sterilization

Which Contraceptive Method is Right for You? Key considerations include: Health risks Implications of an unplanned pregnancy STD risk Convenience and comfort level Type of relationship Ease and cost of obtaining and maintaining each method Religious or philosophical beliefs